Breast cancer neoadjuvant chemotherapy

Neoadjuvant chemotherapy is appropriate for patients with locally advanced or inflammatory breast cancer, followed by local therapy and further adjuvant systemic therapy. 

The use of preoperative systemic therapy is gaining favor in both early-stage and locally advanced breast cancers. This approach to therapy, referred to as neoadjuvant or primary systemic therapy, most often consists of chemotherapy but in special circumstances also may include hormonal therapy (e.g., in inoperable patients with significant comorbidities). The advantages of preoperative systemic therapy include... 

Locally advanced breast cancer often is treated with neoadjuvant therapy to make the tumor surgically respectable. During neoadjuvant chemotherapy, laboratory values to monitor chemotherapy toxicity are obtained prior to each cycle of chemotherapy, and a physical examination and ultrasound exams to detect size of tumor are performed after the cycles of neoadjuvant therapy are completed. After a complete surgical resection, monitoring proceeds as described earlier for early breast cancer. 

The goal of neoadjuvant chemotherapy in locally advanced breast cancer is cure. Complete pathologic response, determined at the time of surgery, is the desired end point. 

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Neoadjuvant treatment of breast cancer has traditionally been used in inflammatory breast cancer, mainly in those patients not amenable to radical surgery and radiotherapy. The aim of the treatment is a downstaging of the disease. However, this approach can also be applied to tumors that are not initially suitable for conservative surgery but may become so post-chemotherapy. The overall survival outcomes are similar for the pre- and post-surgery approaches. 

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Ayers M, Symmans WF, Stec J, Damokosh Al, Clark E, Hess K, et al. Gene expression profiles predict complete pathologic response to neoadjuvant paclitaxel and fluorouraril, doxorubicin, and cyclophosphamide chemotherapy in breast cancer. J Clin Oncol 2004 22(12)2284-2293. 

Mathieu MC, Rouzier R, Llombart-Cussac A, et al. The poor responsiveness of infiltrating lobular breast carcinomas to neoadjuvant chemotherapy can be explained by their biological profile. Eur J Cancer. 2004 40 342-351. 

Bhargava R, Beriwal S, Dabbs DJ, et al. Immunohistochemical surrogate markers of breast cancer molecular classes predict response to neoadjuvant chemotherapy A single institutional experience with 359 cases. Cancer, in press. 

Buzdar AU, Ibrahim NK, brands D, et al. Significantly higher pathologic complete remission rate after neoadjuvant therapy with trastuzumab, paditaxel, and epimbidn chemotherapy Results of a randomized trial in human epidermal growth factor receptor 2-positive operable breast cancer. J Clin Oncol 2005, 23 (published ahead of print). 

Yang SX et al. Gene expression profile and angiogenic markers correlate with response to neoadjuvant bevacizumab followed by bevacizumab plus chemotherapy in breast cancer. Clinical Cancer Research 2008 14 5893-5899. 

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Sundstrom S, Bremnes R, Aasebo U, et al (2004) Hypofrac-tionated palliative radiotherapy (17 Gy per 2 fractions) in advanced non-small cell lung carcinoma is comparable to standard fractionation for symptom control and survival a national phase 111 trial. J Clin Oncol 22 801-810 Taghian AG, Abi-Raad R, Assaad SI, et al (2005) Paclitaxel decreases the interstitial fluid pressure and improves oxygenation in breast cancers in patients treated with neoadjuvant chemotherapy clinical implications. J Clin Oncol 23 1951-1961... 

Fig. 2.7.7. a In this patient with a history of breast cancer first detected several years ago, progressive hepatic metastases developing during polychemotherapy were noted. Since re-staging confirmed no extrahepatic metastases the patient qualified for therapy, b Then 12 months after microparticle embolization progressive shrinkage of the metastases can be appreciated. However, at the same time new hepatic metastases were detected in the left liver lobe prompting neoadjuvant chemotherapy... 

J. -H. Chen and M.-Y. Su, Clinical Application of Magnetic Resonance Imaging in Management of Breast Cancer Patients Receiving Neoadjuvant Chemotherapy, BioMed Res. Int, 2013, 348167. 

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